Credentialing and Contracting

Practicing medicine is difficult in today’s complex world of compliance and paperwork.   The credentialing process is no different – it is detailed, complex and cumbersome.  Proper credentialing with payer networks is imperative to ensure that a provider does not lose the ability to provide care to patients in a network, and to eliminate the possibility that the payer may pay only a partial claim and require the patient to pay the balance.

You can save time and eliminate the complexities that the provider enrollment and credentialing process entails.   Kaleidoscope’s professional credentialing team has many years of experience and relationships with both the commercial and government payers.  We know the processes and have the contacts with the payers when challenges arise.   We complete and submit all documentation on your behalf – both paper and electronic.   We then assertively follow-up with necessary phone calls, faxes or emails to track the status of each application.   This ensures that  the process is completed efficiently and timely.  We provide regular Status Update Reports and phone conferences or meetings as needed.

Our Services Include:

  • Credentialing with major commercial carriers, local and national; and Medicare and Medicaid in multiple states and jurisdictions
  • Enrollment and re-enrollment (Re-credentialing)
  • Maintenance  – Ensure that providers are recredentialed and documentation is maintained
  • Medicare Revalidation
  • CAQH and MN Credentialing Form Completion and Tracking
  • Licensing and License Renewals
  • Medical Staff Privileges and updates

 

Timeline for Credentialing:

The turnaround time to credential with the payers will vary from payer to payer and will be longer if the provider or group is newly established.   Typically you can plan approximately 60 to 120 days for the process.  Most payers do not backdate effective dates so it is imperative to coordinate the provider’s actual date of providing patient care to the effective date of each network that you are participating in.

 

Maintenance and Organization Service:

Kaleidoscope can provide ongoing maintenace service to ensure that your revenue is not compromised when it is renewal or recredentialing time.   Failure to meet renewal dates may result in a provider’s loss of the ability to bill or even practice.   We will track renewal dates and maintain copies of your documentation.   This relieves you of the need to staff this process and you can focus on quality patient care.

 

For more information Contact Us……